From Recognition to Redistribution: What Women’s Equality Day Asks

Maria Panzera Rugg’s Women’s Equality Day reflection on Personal Support Workers/Care Aides named something that shouldn’t need naming, but it does, that the women sustaining Canada’s home care and long-term care system, disproportionately immigrant and racialized women, are serving the most vulnerable people in the country while being profoundly vulnerable themselves. Her reflection is clear that there is no gender equity without care equity, and that PSWs and Care Aides deserve fair wages, stable hours, paid sick days, safe workplaces, and a real seat in decision-making.

Recognizing the inequity PSWs and Care Aides face, as urgent and necessary as that is, is only part of the story. The rest of the story is asking a harder structural question: if we know this workforce is being asked to absorb far more than it should have to, what must change so the weight of care is shared equitably, and properly resourced, across the system?

The Numbers: Who Actually Holds Up the System

Let’s start with the scale. Women make up more than 75% of Canada’s health care workforce overall¹, and in Ontario’s health care and social assistance sector specifically, that figure rises to 81%², compared with 47% of the workforce across all industries. This is not a coincidence of who happens to apply for these jobs. Caregiving, in Canada as elsewhere, has been coded as “women’s work” for generations, and the health system has been built on the assumption that it will keep being done, largely by women, most often for less.

If we look closer at who is doing the closest, most hands-on work, the picture sharpens further. Health care aides and personal support workers (PSWs/Care Aides), titles that vary by province but describe the same role, provide up to 80% of the direct care that older Canadians receive, whether in long-term care or at home³. A study of PSWs in the Greater Toronto Area found the workforce was 90% women, 90% racialized, and 97% born outside Canada, with the majority identifying as Black⁴. Racialized women make up just 13% of Ontario’s overall workforce, but 25% of workers are in nursing and residential care facilities and 27% of workers are in home health care services. This is roughly twice their share of the general workforce⁵. Long-term care’s direct-care workforce is described in recent research as “most racially diverse and female”⁶, even as staffing levels in several key long-term care roles have been declining⁷.

This is what it looks like when a system quietly builds a system of care on the labour of a specific group of women to function, while continuing to underfund that labour labelling them as low-skill, low-status, and low-priority.

The Weight Currently Falls in One Place

Right now, in Canada, an enormous amount of the informal and formal labour of dying, caregiving, and grief support falls onto a narrow band of people: family caregivers (still overwhelmingly women) and a formal paid workforce of PSWs and HCAs (also overwhelmingly women, and disproportionately racialized and immigrant women) who routinely stretch beyond their paid hours to fill the gaps nobody else is covering.

This is not sustainable for them, nor the system, and it was never supposed to be permanent. Canada’s own health promotion model for palliative care assumes something quite different: that only around 10% of the support a dying person and their family need should come from the formal health care system, with the remaining 90% coming from the surrounding community of neighbours, faith groups, workplaces, volunteers, informal networks⁸. Right now, that 90% isn’t being filled by a broad, resourced community. It’s being absorbed, invisibly and for free, by whoever happens to be closest, and very often, that is the same PSWs and HCAs who are already underpaid for their formal shifts, along with the family members standing beside them.

Compassionate Communities: An Answer, If Built Properly

This is where the compassionate communities model becomes genuinely relevant to the equity conversation. Developed from the work of Professor Allan Kellehear and adopted as a public health approach to palliative care, the compassionate communities movement treats death, dying, caregiving, and grief as everyone’s responsibility and not something to be outsourced entirely to health professionals, family members, or paid care workers alone^9,10.

Canada has become a genuine leader in this movement: by 2023, more than 223 Compassionate Community initiatives were operating across the country, coordinated through organizations like the BC Centre for Palliative Care and Hospice Palliative Care Ontario¹¹. A distinctly Canadian model for developing compassionate communities, grounded in participatory, community-led capacity-building rather than top-down programming, has also been developed and tested across diverse Canadian communities, including rural and First Nations contexts¹².

Done well, a compassionate community redistributes the emotional and practical load of caregiving across a much wider circle: trained neighbours checking in, workplaces with real bereavement and caregiving policies, faith communities offering meals and companionship, volunteer networks providing respite¹⁰. That is precisely the kind of structural redistribution that could relieve pressure on both unpaid family caregivers and an overstretched paid workforce, if it’s resourced as genuine infrastructure rather than treated as a free substitute for formal care.

The Trap to Avoid

That caveat matters enormously, and it’s worth stating plainly: compassionate communities must never become a rationalization for under-resourcing the paid care workforce. If “the community will help” becomes an excuse to keep PSW/Care Aides wages low, hours precarious, and training investment minimal, then the compassionate communities’ model simply shifts the same undervalued, feminized labour from one unpaid or underpaid setting to another. Community capacity-building must be an addition to a properly funded, properly staffed, properly paid formal care system and not a cheaper replacement for one.

The Resources for Palliative Care Have Not Kept Pace with Need

This is where the funding conversation becomes unavoidable. Canada’s population is aging quickly with annual deaths being projected to reach roughly 330,000 by 2026 and 425,000 by 2036¹³. And while three-quarters of Canadians say they’d prefer to die at home, access to palliative home care remains an ongoing gap^13,14, with progress on the national Framework on Palliative Care described by stakeholders as slow. Many respondents to a recent survey reported no meaningful change in evidence-based guidelines, outcome measurement, or progress tracking for palliative care nationally, and flagged that palliative care research itself remains chronically underfunded¹⁵.

Federal investment has grown. Budget 2021 committed roughly $30 million toward the Action Plan on Palliative Care, and Budget 2023 confirmed close to $200 billion in health funding over ten years, including $46.2 billion specifically intended to support the health workforce, including personal support workers¹⁶. But funding announcements and system-wide resourcing are not the same thing. Real “resources for palliative care” means adequate staffing ratios, standardized training and credential recognition for PSWs and HCAs across provinces, sustained funding for compassionate community infrastructure, and wages that reflect a living wage and the skill this work actually requires, not a patchwork of time-limited grants layered on top of a workforce still absorbing the gaps for free.

What Equity Actually Requires

Bringing these threads together, building genuine equity into Canada’s palliative care system means holding several things true at once:

• Fair labour conditions for PSWs and HCAs – living wages, stable hours, benefits and safety. As Maria’s reflection rightly states, and as the foundation everything else is built on top of.

• Investment in compassionate communities as real infrastructure – trained volunteers, funded community programs, workplace caregiving policies, so the “everyone’s responsibility” model actually distributes the load rather than quietly reabsorbing it into the same underpaid hands.

• Adequate public resources for palliative care – sustained funding, standardized training, and system-level accountability, not one-time grants substituting for structural investment.

• A genuine palliative approach woven through every layer of this system – formal and informal, professional and volunteer, so that skill, presence, and dignity are recognized wherever care is happening, not only inside clinical settings.

Where Life and Death Matters Fits

This is the reason Life and Death Matters exists for different palliative care providers. Our training resources support professional PSWs, HCAs and nurses whose skilled labour deserves proper recognition and investment as well as instructors and educators who prepare learners and teams to do this work with confidence and compassion.  

Our courses, PACE for PSWs and our free, publicly accessible introductory training on a palliative approach to care are built to offer practical, flexible, relevant and supportive learning and content to build important palliative care skills. The introductory course supports the wider circle a compassionate community depends on including family caregivers, volunteers, and community members learning to show up for someone who is dying or grieving.

Women’s Equality Day asks us to recognize the women holding up this system. What comes next is redistributing the weight they’re carrying across a properly resourced formal workforce, a genuinely supported compassionate community, and a system finally funded to match the need it already knows is coming.

References

1. Canadian Institute for Health Information. Health Workforce in Canada: Overview.
2. Job Bank, Government of Canada. Health Care and Social Assistance (NAICS 62): Ontario Sectoral Profile.
3. The evolving role of health care aides in the long-term care and home and community care sectors in Canada. PMC.
4. Sinha SR, et al. Precarious work among personal support workers in the Greater Toronto Area: a respondent-driven sampling study. CMAJ Open. 2022;10(2):E527.
5. Personal support workers are the backbone of health care but the bottom of the power structure. The Conversation.
6. Why Canada must transform its long-term care system. The Conversation.
7. Canadian Institute for Health Information. Recent staffing and quality indicator trends in Canadian long-term care.
8. Hospice Palliative Care Ontario. Compassionate Communities.
9. Tompkins B. Compassionate Communities in Canada: it is everyone’s responsibility. Annals of Palliative Medicine.
10. BC Centre for Palliative Care. Compassionate Communities.
11. Government of Canada. The Framework on Palliative Care in Canada — Five Years Later: A Report on the State of Palliative Care in Canada.
12. Developing a compassionate community: a Canadian conceptual model for community capacity development. PMC.
13. Government of Canada. Framework on Palliative Care in Canada.
14. Canadian Institute for Health Information. Access to Palliative Care in Canada.
15. Is progress being made on Canada’s palliative care framework and action plan? A survey of stakeholder perspectives. PMC.
16. Government of Canada. Government of Canada Supports Lakehead University’s project to assist underserved populations in receiving palliative care services. Health Canada news release, 2024.